动力性中前足功能重建结合踝关节融合治疗足下垂的临床研究

Clinical Study on Dynamic Reconstruction of Mid-Forefoot Function Combined with Ankle Arthrodesis in the Treatment of Foot Drop

摘要: 目的：探讨动力性中前足功能重建结合踝关节融合治疗足下垂的手术疗效。方法：回顾性分析2018年8月至2023年4月青岛大学附属烟台毓璜顶医院关节骨科治疗并获完整随访的29例足下垂患者。根据Takakura踝关节炎分期标准对患者的踝关节炎严重程度进行分期。手术方法为经胫后肌腱止点切开后转位，分别吻合趾长伸肌及将腱骨固定于中间楔骨以重建中前足动力，同时行外踝截骨螺钉固定的踝关节融合术。统计患者的术后主观满意度。采用美国足踝外科协会(AOFAS)及视觉模拟评分(VAS)评价术前及末次随访时的足踝部功能。采用德国科德曼(Cordewener)步态检测仪记录步频、步速和步幅并评价术前及末次随访时的步行能力。结果：29例患者获得12~49个月随访，28例主观满意。AOFAS和VAS评分分别由术前(50.79 ± 12.01)、(6.26 ± 1.63)分改善为末次随访时(78.58 ± 9.56)、(1.63 ± 1.12)分(P < 0.01)。步频、步速和步幅的值分别由术前(68.79 ± 12.28)、(34.21 ± 11.71)、(55.21 ± 13.60)改善为术后1年随访时(105.32 ± 10.14)、(88.26 ± 9.83)、(100.84 ± 10.90) (P < 0.01)。27例患者经CT证实完全骨性融合，2例显示不全融合的患者中1例持续内侧疼痛给予局部封闭后疼痛缓解，1例行返修术恢复良好。结论：足下垂患者的病史长，多合并踝关节炎，做踝关节融合术缓解疼痛的同时，结合胫后肌腱转位动力性重建中前足功能，以恢复行走能力，手术安全、并发症少且疗效较好。

Abstract: Objective: To investigate the therapeutic effect of dynamic mid-forefoot functional reconstruction combined with ankle joint arthrodesis in the treatment of foot drop. Methods: From August 2018 to April 2023, a retrospective analysis was conducted on 29 patients with foot drop treated in the orthopedic department of Yantai Yuhuangding Hospital, affiliated with Qingdao University. The severity of ankle arthritis in patients was graded according to the Takakura ankle arthritis staging criteria. The surgical procedure involved cutting the insertion of the posterior tibial tendon, transposing and suturing it to the extensor digitorum longus, and fixing the tendon bone to the middle cuneiform to reconstruct the dynamic function of the mid-forefoot, followed by ankle joint fusion with screw fixation through a lateral malleolar osteotomy. Postoperative subjective satisfaction was measured. Foot and ankle function were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) scores and Visual Analogue Scale (VAS) before surgery and at the last follow-up. Stride frequency, stride speed and stride length were recorded by a German Cordewener gait detector to assess walking ability before surgery and at the last follow-up. Results: All 29 patients were followed up for 12~49 months, and 28 patients were subjectively satisfied. The AOFAS and VAS scores improved from (50.79 ± 12.01) and (6.26 ± 1.63) preoperatively to (78.58 ± 9.56) and (1.63 ± 1.12) at the last follow-up (P < 0.01). Stride frequency, stride speed and stride length also improved significantly from (68.79 ± 12.28), (34.21 ± 11.71) and (55.21 ± 13.60) preoperatively to (105.32 ± 10.14), (88.26 ± 9.83) and (100.84 ± 10.90) at the one-year follow-up (P < 0.01). 27 patients were confirmed to have complete bone fusion by CT, while 2 patients showed incomplete fusion. Among them, 1 patient experienced persistent medial pain and received local closure to relieve pain, and 1 patient underwent revision surgery and recovered well. Conclusion: Foot drop patients often have a long history and are frequently complicated by ankle arthritis. Performing ankle arthrodesis to relieve pain, in combination with tibialis posterior tendon transfer for dynamic reconstruction of midfoot and forefoot function, aims to restore walking ability. This surgical approach is associated with a high safety profile, minimal complications, and favorable clinical outcomes.